"Participation Agreement Form and Variations" is a American Lawyer Media form. This is a participation agreement form with different variations.
Maine Participation Agreement Form and Variations
State:
Multi-State
Control #:
US-PA197
Format:
Word;
PDF;
Rich Text
Instant download
Description
Free preview
How to fill out Participation Agreement Form And Variations?
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FAQ
MaineCare provides free health insurance, other health benefits, and assistance to childen and young adults under age 21 who meet income guidelines or disability criteria.
To check your application status call MaineCare Member Services at 1-800-977-6740.
You may be eligible for MaineCare if your monthly income (before you pay taxes) is up to: Your household sizeChildrenAdults (21-64)1$2,588$1,6772$3,501$2,2683$4,413$2,8594$5,325$3,4501 more row
If you'd rather apply in person, call your local office or the Maine SNAP hotline (1-800-442-6003) to find out how. Learn if you're eligible for food stamps.
Income & Asset Limits for Eligibility 2023 Maine Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleIncome LimitAsset LimitInstitutional / Nursing Home Medicaid$2,742 / month*$10,000?Medicaid Waivers / Home and Community Based Services$2,742 / month?$10,000?1 more row ?
Complete and return the renewal form by mail or go to MyMaineConnection.gov. If you don't complete your renewal before the due date, your MaineCare coverage will end.
Contact Us Eligibility and Benefits Questions. Phone: 1 (855) 797-4357. For help logging into your My Maine Connection Account: MMCHelp.DHHS@maine.gov. Electronic Benefit Transfer Card. For EBT self-service, please visit
If you have questions or concerns about your EBT or P-EBT account please call the number on the back of your card, (800) 477-7428, or the OFI Call Center even if you get a text or e-mail asking you to contact a different number.
Contacts for Members To apply for MaineCare, or to report changes to your name, address, phone number, income, assets, or household makeup, call the Office for Family Independence at: 1-800-442-6003 (TTY 711). Current MaineCare members may contact Member Services for information about MaineCare-covered services.